Curtis C. Stine

Condom effectiveness: Factors that influence risk reduction

This paper summarizes the proceedings of a workshop convened in June 2000 by four federal agencies to evaluate the published evidence establishing the effectiveness of latex male condoms in preventing HIV/AIDS and other sexually transmitted diseases. It reviews a discussion of other factors that influence condom effectiveness.

The role of disease-specific infectivity and number of disease exposures on long-term effectiveness of the latex Condom

Background Condom use is a primary prevention strategy for sexually transmitted infections (STIs). Consistent condom use substantially reduces the risk of HIV infection. Similar levels of effectiveness for reducing the risk of other STIs have not been established. Differences in disease-specific infectivity and the number of exposures to an infected partner may explain differences in condom effectiveness. Goal The goal was to examine the impact of differing infectivities and increasing numbers of exposures on theoretical condom effectiveness. Study Design Mathematical modeling using estimated disease-specific infectivities and condom failure rates. Results Condom effectiveness decreases as disease-specific infectivity and the number of exposures to infection risk increase. Conclusions Condom effectiveness for decreasing STI risk is influenced by disease infectivity and the number of exposures. Generalizations from studies of relatively uninfectious STIs to highly infectious STIs or from short-term studies to longer-term situations will overestimate condom effectiveness.

What Words Should We Use When Discussing Excess Weight

Background: There is limited research on how patients prefer physicians to communicate about the topic of obesity, and there is even less understanding of which terms physicians most commonly use. Methods: In this cross-sectional, nonrandom sampling study, patients who were seeking treatment for weight loss rated the desirability of 12 terms to describe excess weight, and physicians rated the likelihood with which they would use those terms during clinical encounters. Participants rated terms on a 5-point scale, with −2 representing “very undesirable” or “definitely would not use” and +2 representing “very desirable” or “definitely would use.” Results: Patients (n = 143; mean age, 46.8 years; mean body mass index, 36.9 kg/m2) rated “weight” (mean ± SD) as the most desirable term (1.13 ± 1.10), although it did not significantly differ from 5 other terms provided. They rated “fatness” (−1.30 ± 1.22) as the most undesirable term, although this rating did not differ significantly from 4 other terms. Physicians affiliated with a community-based medical school (n = 108; mean age, 48.8 years; 79.6% primary care specialty) were most likely to use “weight” (1.42 ± 0.89), which was significantly different from ratings for all other terms. They were least likely to use “fatness” (−1.74 ± 0.59), although this rating did not differ significantly from 3 other terms. Conclusion: Physicians generally reported that they use terminology that patients had rated more favorably, and they tend to avoid terms that patients may find undesirable. Understanding the preferences and terminology used by patients and physicians is an important initial step to ensure that communications related to obesity and weight loss are efficient and effective.

Modification of Sexual Behaviors Is Important for the Prevention of Human Papillomavirus Infection

There is currently no effective HPV vaccine or curative treatment for HPV infection. Therefore, any comprehensive approach toward the prevention of HPV infection must include efforts to reduce high-risk sexual behavior. Since condom use has not been proven to be effective for the prevention of HPV infection [4], encouraging young people to delay the onset of sexual activity and promoting the health benefits of long-term monogamy, both of which are evidence-based strategies, seem most likely to be effective. In fact, the recent national emphasis on promoting abstinence may already be having a positive effect, as evidenced by the significant decline, between 1991 and 2001, in levels of sexual activity among high-school students [5].